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General NPI Number Information
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NPI Number | 1528160611
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Entity Type | Organization
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Legal Business Name | HARRIS TEETER, LLC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11806 SPECTRUM CENTER
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City | RESTON
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State | VI
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Zip | 20190
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Country | US
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Telephone | 703-435-0400
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Fax | 704-844-6556
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Provider Business Mailing Address
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Address Line | 701 CRESTDALE RD
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City | MATTHEWS
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State | NC
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Zip | 28105-1700
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Country | US
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Telephone | 704-844-3100
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Fax | 704-844-6556
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Authorized Official
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Title or Position | MANAGER, PHARMACY ADMIN/AR
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Name | ROSE WARD
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Credential |
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Telephone | 704-844-6524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201003810
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License Number State | VA
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